Wednesday, February 02, 2005

Someone wait for you to breathe again

Hello Everyone

I am sorry to be late again since I was very busy in the last four days in the hospital & I didn't see my mom since 29th of January, but today I returned back home for one day holidayJ. I was very happy there in the hospital even I was very tired bcz of the a lot of work which I had to do even when I lack some of the required equipments for that work & I didn't sleep to much bcz of that. I slept an average of 3-4 hr a day only but believe me when I say it worth it.

There were very interesting cases that I faced during these days, some of them feel me sad & the other feels me happy even if death was coupled with these cases:

The sad case that I had faced was in the 30th of January when a pregnant woman with her 2nd trimester of pregnancy presented to the hospital with severe case of Clampsia ( severe hypertension occur in certain woman through pregnancy) & in the cases of Clampsia we must lower the blood pressure or there will be death. Unfortunately, she admitted to us in the night & we couldn't find an Antihypertensive injection that's used in this case & we couldn't even search for it in the other hospitals bcz of the curfew in the night. So we tried to help by giving normal Anithypertensive drugs but there was no use in giving her these drugs!!! So after 3:30 AM, doctors decided to remove the embryo to lower the blood pressure & save the mother's life & they did to save her life even when her family told us that it was her first pregnancy after 6 years of marriage & they wanted that baby very much. The operation was an unsuccessful one & embryo couldn't make it & die after 1hr of the removal operation, but the mother was still had hypertension!! We tried finally to give her (Beta-blocker drugs) & (Diuretics) but the mother couldn't make it & died at 6:15 AM. I felt very sad cz of this case bcz it was a very simple cz & can be cured easily with one injection only & that's why that the mortality rate is high in Iraq.

The Happy case was in 30th of January noon when an old man admitted to the hospital with complete comma, he was unconscious & showed no signs of life. When I was taking the history from his son, he told me that his father age was 74 yrs old, had many disease like DM(diabetes Mellitus),gout & peptic ulcer but even though he insisted to vote & he fall down on ground after he had voted in the voting center ( in the way back to their home in Al-Kadmia city). I was very happy for him bcz he could vote before his death & I believe that's was a sign from God for us to vote, so plz tell every one who don't believe in Democracy in Iraq this story which represent the braveness of Iraqis & their strong willing.

There were many other interesting cases I saw but I will tell u them in other time cz I'm tired now, so plz forgive meJ.

I want to thank everyone who paid in the pay pal or wrote sweet words & I can tell that that was a big support to me & to my friends to go on & continue what we had begun. I repeat my Thanks for every one paid even a shilling & specially (Nancy C., Rei F., Robert O., Mike O., jon v., Kathleen H.).

Today 10 new students join our group. I was happy & sad at the same time: Happy cz the members increase & that's mean that people begin to feels us & understanding what can simple efforts do if they r grouped & well organized. Sad bcz I wish I have enough money, stuff & equipments for them so I will try to limit the group no. to 61 only until there r enough stuff to give or they will be useless even their good feelings & wishes that they have to help Iraq.
I count the total money today & it seems that's enough only for half of the members only (29 members). So I wish u for the sake of Iraq to make extra effort to bring people to visit my blog & if they r convinced by my words, I wish they will help Iraq.

Iraq, Iraqis, & I will not forget ur efforts & will pray for u & wish u all good things, & I will tell my children in the future about ur kindness & also I will tell every Iraqi I will meet about this. Believe me.

I wish u to write comments showing ur opinions but I am sorry bcz I will not be able to read it soon but I swear I will read it later cz I will be busy in the next few days, But if u have something important to tell me u can e-mail me on saif_alsheikh@hotmail.com.

I am so upset with myself! Sorry I didn't come sooner. I think I was too angry at the people posting the negative stuff. This time I noticed and I will read you more often. Love and peace to you and all Iraqi people.

Doctor, I just want you to know that there are many many Americans praying for you and your country--that there be peace, that those who intentionally and gleefully bring harm to innocents (terrorists) be stopped, and that God's mercy would be upon you.

We were so thankful to hear of your successful elections! As a Christian, I can tell you that our church celebrated with you this past weekend. Your words in this blog are another indication that Iraq, long pillaged by a tyrant, is preparing to bloom. Take heart, have courage, keep doing good even when you're tired of hoping, and resist those who do evil!

Did you do a ceasarian or did you induce labor. It is not generally recommended to do surgical ceasarians, is it? Shouldn't you have induced with pitocin after treating with a corticosteroid - do you have that available? Could she have had an epidural and oxygen while delivering?

Assuming you did inject her with angiotensin-converting-enzyme, that would only harm the fetus and not her - it should have brought her high blood pressure down. If it wasn't an angiotensin-converting-enzyme it was probably safe for the fetus. Was there protein in her urine? Did she have nausea and vomiting, headache, upper abdominal pain and general malaise? Is it possible she had Hemolysis, Elevated Liver enzymes, and Low Platelet count syndrome? If so, what treatments do you have? Did she also have chronic high blood pressure or was it all gestational? Was she diabetic? Did you determine a cause of death for the pregnant woman?

I didn't get what u meant, but I can ask ur question to the Gynecologist surgent who did the operation. Also i wanna say that we hadn't the injection which i will ask the surgent about what is the kind of drug use in this case, also we didn't make any kind of lab test for the patient sample bcz at that night there was no lab in the hospital & we transform all the dangerous cases to the Hospital of the Medical City in Bab Al-Maatham city, near Haifa St. & there wasn't enough time to transform the case to the other hospital bcz of the curfew so we wanted to wait to dawn but she died before that time.

Saif, thank you for the feedback - i would like to hear more about her treatment and condition - and what symptoms you looked for and what you found. there may be some alternative treatments or dare i say better treatments for her condition

SUGGESTION:1) call the US Army in your town to get them to transfer patients in evening hours - or at any hour - for safety between hospitals - i have a strong feeling that they would not only help with transport but also with treatment if asked - do you have their phone numbers or web addresses readily at hand?

2) get some web help so that you can talk on-line for help or ideas - there are a lot of on-line medical resources you can subscribe to that have ways to diagnose and treat patients - also get some people say even in israel or the army or whatever to be people that you can call upon for phone consultation when a patient is suffering like this and you are running out of options.

News in favor and in support to American troops and Iraq freedom against false propaganda pro-saddam from antiwar.com and another scum reads here in english,german and spanish www.libertadedigital.com,www.asturleonesdesdeelexilio.blogspot.com. Greetings, Bashir kHAMDAM.

I agree with Ann to ask military for assist in cases like this. There has to be some kind of arrangement for escort that can be made in the cases of medical emergency. I feel so badly about this young woman and her baby dying.

Ann - I experienced pre-eclampsia with my first (and second, too now that I think of it). With the first it progressed post-partum to the point that my kidneys shut down. Up until I just stopped pee-ing, there was only trace amt of protein in my urine - one reason they were never too concerned about anything. It is possible for women to be in danger from this even in America where the best medical care and diagnostic testing is available. Criminy - the skin on top of my feet had little splits in it I had so much fluid in me. The little lines of scabs didn't go away for a week.

It sounds like you're raking the poor man over the coals for this. I'm sure that they did all that they were capable of doing considering the situation that they are in.

On the other hand - it may just be scientific curiosity on your part. If so - then I apologize for saying that you're raking the man over the coals.

Not raking over the coals, and he's a big boy and probably used to probing questions about treatment regardless of success or failure in the outcome. Medicine is that way - always seeking always questioning. In the art of medicine, one never has all the diagnostic tests and available resources at their hands. It's a matter of creatively using what you do have - and it sounds like they were doing just that. What if there were no curfew? Would they have really had time - it seems that the surgery was rushed? Or would she have died anyway?

She died from one of the leading causes of death during pregnancy in developed countries. Pregnancy-related hypertension is considered the cause of death for about 16% of maternal mortalities in the US. The exact cause of death is an important question: was it renal failure, brain haemorrhage, seizure-related injury, bleeding to death?

I would like to know if she died of acute interstitial nephritis - a shut down of the kidney - I suspect it could be so and that it was caused by shock of surgery and diuretics. I was also wonder if she showed signs of proteinuria, edema, or convulsions, as this was not stated. Isn't it true that before the third trimester, hypertension is usually from a pre-existing condition or gestational hypertension but not from preclampsia or eclampsia (toxemia)? Just curios really. What was it they were trying to do? Was it to reduce risk of seizure? If it was a 2nd trimester preclamspis, then if Magnesium sulfate was the medicine they wanted and didn't have, did they look around for Dilantin or Valium instead? That's suggested here: http://www.aafp.org/afp/20041215/2317.htmlThat resource lists some other medicines that are known to have worked on other cases.

Diuretics for hypertension aren't typically given during pregnancy because of the ill effects on the neurodevelopment of the fetus, though this sounds like it happened after the fetus was taken. Diuretics are fine for typically reducing hypertension in non-pregnant women, and for reducing edema in pregnant women, but with the possibility of renal failure in a preeclampic case, are diuretics still advisable? I don't know - it seems like not - but I really don't know here.

The other bothersome aspect of this post is that the case is one considered within studies of gendercide. That Human Rights Watch and UNICEF and such are studying the some 585,000 women who die annually from complications arising from pregnancy and childbirth. Over 200,000 die of haemorrhaging as there is no medical assistance readily available to them. About 75,000 more die from attempting to abort their pregnancy themselves (some 50,000 attempt are estimated each day). About 75,000 more die with brain and kidney damage in the convulsions of eclampsia. About 100,000 die of sepsis, the bloodstream poisoned by a rising infection from an unhealed uterus or from retained pieces of placenta, bringing fever and hallucinations and appalling pain. About 40,000 a year die of obstructed labour. For the most part, international organizations are blaming these high results on gendercide or even genocide - the artifical selection arising from politics. We know that Iraq had one of the highest infant mortalily, maternal mortality, and young child 0-5 mortality rates in the region. We know this was politically motivated and the OIF funds were abused. Of the complications above that result to 1 woman dying on this planet every minute, less than one percent of these types deaths occur in developed countries. These deaths are preventable if resources and services were available.

This post seems to suggest that the US was irresponsible and perhaps even a cause of one of those deaths because there seems to be blame on the curfew alone - and not lack of equipment at the facility or that she didn't get proper prenatal treament or waited to long to arrive at the hospital. It is upsetting to have the US or Coalition accused of such, and I know that we are not that way. I know that if there was anything the US could have done to assist in her treatment, we'd have been there do all possible. I know this in my heart of hearts.

Ann I agree that if a coalition hospital were aware of her condition they would have done everything to save her. I believe that the Iraqi doctors did what they were able to do for her with what they had. It sounds to me like the mag. wasn't available. This doesn't surprise me knowing what we know of the situation under Saddam and the sorry state of maternal/fetal medicine. Well - all medicine actually. I can't believe that things have improved much yet. The baby was removed which usually fixes the problem almost immediately from what I understand. When it didn't then other stop-gap measures were employed in hopes that something might help.

I guess I hadn't read an accusation of US responsibility for her death in the original post as you did. Just very sad deaths in a very difficult and imperfect situation.

Monica, The literature suggests that taking the baby usually allieviates this problem - but why would the curfew matter for taking the baby - they should be able to do that. Also, I think (correct me, if otherwise) that it is best to induce for delivery of the baby but not to do a C-section in this case. It sounded like they did a C. Why??? My *guess* is that there were other options, and not just the beta blockers and diuretics. I'm not sure about the use of diuretics when HELLP symptoms are present again let me know what you know. That wouldn't seem like the way to go unless she had extreme edema - would it?

I don't know for sure, but I felt like this post had a LOT of emphasis on blaming a curfew for something that either could or should have been treatable at that hospital - or is a case that modern medicine has no reliable cure for. The curfew is there to save lives, not take them. While it is an injustice towards liberties, the security situation makes it advisable for the safety of their community.

What were the other mitigating factors that affected her case? Was she receiving proper prenatal care? Did she follow the advice and did she come to the ER when she needed to? What were the alternatives? Why did they do a C instead of inducing? Why did they chose beta blockers and diuretics? How long did they wait for the anti-hypertension injections to work? What were they symptoms she showed - for example, was she experiencing seizures? What was the cause of death?

The curfew may have had nothing to do with the situation. That is why it is important to go back and think things through. It is not a matter of criticizing or blaming people; doctors become doctors because they want to do everything they possibly can do to save lives. It is a matter of promoting critical thinking skills and finding out what this hospital really lacks so that future cases progress more successfully. :-)

There may be alot that we can do even here from the US and simply over the internet to promote maternal welfare in Iraq. Since they had the highest infant mortality rate, child mortality rate, and maternal mortality rate (pregnant mothers) in the region and close to highest in the world, I bet that we can use our keyboards and minds to help out. :-) :-) :-) But we need to know the facts: what do they know, what don't they know, what do they have, and what do they need. Then we can persue finding solutions.

Honey - you know waaaaayyyy more than I do about this malady. LOL! All I know is what small research I did after my bastard doctors almost killed me in childbirth in the richest nation on the frigging planet. I'm convinced it's the grace of God being the only reason that I and my kids are alive right now. (Oh - and big credit goes to that night nurse for saving me on the first delivery)

Just one last thing, from what I can see the medical establishment doesn't understand why this happens at all. The most reasonable explanation that I've seen for this problem is that it is an immune issue. That is controversial but it makes the most sense to me but I'm no scientist nor am I a doctor.

Ann, I wanna thank u for ur interest in Iraqi's health. But I wanna tell u something, that I write only the facts which I face in my daily life. & my blog is not a window for accusing whom I want, in any time I want. However, if u read my post a little bit more carefully, u would notice that I wasn't blaming curfew but blaming the shortage of Drugs & staff (specially biochemistry lab staff). & I think that really most of the people read the post understood those facts as Monica R. did.I really think that all these factors were accumulative & led to the death of that unfortunate woman, & I think that her spirit now is flying with her infant in heaven.

& I wanna thank u again Ann for the interest u showed & I wish u would do that always as I like really ur comments

Please do tell us about life in Iraq and know that we care a great deal about your health and safety. I really believe that your hospital should be equipped for treatment of hypertension in pregnancy - especially the emergencies. Transporting a person who is convulsing or close to it or close to losing a child is not the optimal solution. You guys need a quality place for women to have their babies. What are you guys lacking? How can we help? I think that removing the curfew would not have helped her, and that in the long run, while it is not giving people their liberties, it is a healthy thing for people to at least try to get a good night's sleep. I see the curfew as a life saving thing. Maybe that's not the case, but that's just based on what I know.

I suppose that she is in heaven with her infant and it is what I believe and what I want to believe.

Please keep blogging!!! How are the patients in the hospital today? How are your exams going?

Dr. Saif - Thank you so much for your blog. It is extremely uplifting and interesting to have a view into what's happening through a doctor's eyes. I have the utmost respect for you and your compatriots trying to handle medical situations in such difficult times and circumstances. God bless you all. Ann is right about the web though - I am sure you can find out anything you need to know by surfing and using Google. And if you find medical supplies you need, put them in a blog or list on your side-bar. I'm willing to bet that we would all chip in to help you purchase the items you need. Best of luck, doctor.

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The U.S. Government is the nation's largest provider of financial assistance to women & minority owned small businesses. The U.S. Small Business Administration (SBA) is Congressionally mandated to assist the nation’s small businesses in meeting their financing needs. The SBA has small business loan programs and services to meet most small business needs. More information on U.S. Government Small Business Loans can be found at **www.SBASmallBusinessLoans.com**

How do Government SBA Small Business Loans work?

When a small business owner applies to a lending institution for a business loan, the lender reviews the application and decides if it merits a busiuness loan or if it requires an SBA guaranty. SBA backing on the business loan is then requested by the lender. In guaranteeing the business loan, the SBA assures the lender that, in the event the borrower does not repay the loan, the government will reimburse the lender for its loss. By providing this guaranty, the Small Business Administration helps tens of thousands of small business owners get financing they would not otherwise obtain.

How much money can I borrow?

Here are a few examples of what you can get from SBA small business loans programs:

7(a) Loan Guaranty Program

The 7(a) Loan Guaranty Program is the SBA's primary small business loan program. A maximum loan amount of $2 million has been established for 7(a) business loans.

Low Documentation Loan (SBALowDoc)

SBALowDoc is the SBA’s quick and easy program that provides a guaranty on small business loans of $150,000 or less. Once you have met your lender’s requirements for credit, the lender may request an SBALowDoc guaranty for up to 85 percent of the loan amount. You complete the front of a one-page SBA application, and the lender completes the back. At SBALowDoc centers, the agency processes completed applications within 36 hours.

SBAExpress

This method makes it easier and faster for lenders to provide small business loans of $250,000 or less. The SBA provides a rapid response through its PLP processing center in Sacramento, Calif.— within 36 hours of receiving the complete application package. Lenders use their own procedures to approve and service the loans.

CommunityExpress

The CommunityExpress pilot program is designed to spur economic development and job creation in untapped rural and inner city communities by providing loans and technical assistance. Loan proceeds may be used for most business purposes, including start-up, expansion, equipment purchases, working capital, inventory or real-estate acquisitions.To be eligible for CommunityExpress, current or prospective small businesses must be located in low- and moderate-income urban and rural areas.

While CommunityExpress is similar to SBAExpress, here are some differences:

• CommunityExpress lenders, together with the National Community Reinvestment Coalition, provide hands-on technical training and support, both before and after loan closings, through community-based, nonprofit NCRC member organizations.

7(m) Microloan Program

The SBA’s Microloan Program provides very small loans up to $35,000 to small businesses and not-for-profit child-care centers through a network of locally based intermediary lenders. In addition to making the loans, the intermediaries provide management and technical assistance to microborrowers and potential microborrowers.

The length of time for repayment depends on the use of the loan proceeds and the ability of your small business to repay the loan.The term is usually 5 to 10 years for working capital, and up to 25 years for fixed assets such as the purchase or major renovation of real estate or purchase of equipment. There are no balloon payments, prepayment penalties, application fees or points permitted with these small business loans. Repayment plans may be tailored to each individual small business.

How do I get started?

You submit a business loan application to a lender for initial review. If the lender approves the business loan subject to an SBA guaranty, a copy of the loan application and a credit analysis are forwarded by the lender to the nearest SBA office. After SBA approval, the lending institution closes the business loan and disburses the funds; you make monthly loan payments directly to the lender. As with any loan, you are responsible for repaying the full amount of the loan. Visit **www.SBASmallBusinessLoans.com** for more info.

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